Stimulant Research Articles

Sex differences among patients with intentional poisoning presenting to the emergency Department at a Tertiary Care Centre in Beirut, Lebanon.

Poisoning poses a worldwide public health challenge and recent data from Lebanon in 2020 revealed that over half patients presenting with acute toxicological exposure intentionally poisoned themselves, primarily with suspected suicidal intent. This study aims to assess sex disparities in intentional toxicological exposures among patients presenting to the Emergency Department, at a tertiary care centre in Lebanon. This was a secondary analysis of an existing toxicological database, including patients aged 6 years and older admitted due to acute overdose from March 2015 to August 2022. A total of 444 cases of intentional poisoning were analysed, with 302 (68.0%) women. The primary cause of intentional poisoning was suspected suicide in both sexes, significantly more common in women (85.1% versus 65.5%, P < 0.001). Specific agents exposed to patients varied by sex; sedatives/hypnotics/antipsychotics, antihistamines, and melitracen/flupentixol were significantly more prevalent in women (P < 0.001) while men showed higher prevalence for ethanol (P = 0.02), stimulants, street drugs and opioids (P < 0.001). Our study underscores substantial sex differences in intentional poisoning cases in Lebanon. Women exhibited a higher likelihood of exposures to sedatives/hypnotics/antipsychotics, antihistamines and melitracen/flupentixol, while stimulant drugs, ethanol, and opioids were prevalent in men. Developing proper and effective sex-specific measures may mitigate potential physical and psychological consequences.

Risperidone suppresses caffeine-induced hyperthermia and hyperactivity in rats

Caffeine, a methylxanthine alkaloid, works as a nonselective adenosine receptor antagonist. It is the most widely used psychostimulant drug worldwide. However, caffeine overdose can lead to acute intoxication, posing a clinical problem. Hyperthermia and hyperactivity are associated issues with acute caffeine intoxication; however, no definitive treatment exists. This study aimed to assess the ability of risperidone to attenuate caffeine-induced hyperthermia and hyperactivity while elucidating the unknown mechanisms of caffeine intoxication. The rats received intraperitoneal injections of saline, risperidone (0.25 mg/kg, 0.5 mg/kg), WAY-100635, ketanserin, haloperidol, sulpiride, or SCH 23390, 5 min after the administration of caffeine (25 mg/kg). Subcutaneous temperature and activity counts were measured using nano tag ® for up to 90 min. In vivo microdialysis was used to determine the effect of risperidone on caffeine-induced elevation of dopamine (DA), serotonin (5-HT), and noradrenaline (NA) concentrations in the anterior hypothalamus. Rats were injected with caffeine (25 mg/kg), followed by saline or risperidone (0.5 mg/kg) 5 min later. The levels of DA, 5-HT, and noradrenaline were measured every 15 min for up to 90 min after caffeine administration. Risperidone and 5-HT2A receptor antagonist ketanserin attenuated caffeine-induced hyperthermia and hyperactivity. Haloperidol and dopamine D1 antagonist SCH-23390 exacerbated hyperthermia without any effect on the hyperactivity. In the microdialysis study, risperidone treatment further attenuated caffeine-induced 5-HT elevation, but not DA and NA. Our results indicate that risperidone attenuates caffeine-induced hyperthermia and hyperactivity by blocking 5-HT2A receptor activity and may be potentially useful for treating caffeine intoxication.

Neurofeedback Training in Children with ADHD: A Systematic Review of Personalization and Methodological Features Facilitating Training Conditions.

Objective. Current research on the effectiveness of neurofeedback (NFB) in children with attention-deficit/hyperactivity disorder (ADHD) is divided. Personalized NFB (pNFB), using pre-recorded individual electroencephalogram (EEG) features, is hypothesized to provide more reliable results. Our paper reviews available evidence on pNFB effectiveness and its methodological quality. Additionally, it explores whether other methodological features implying personalization are related to successful NFB. Methods. We conducted a systematic literature review on PubMed, PSYNDEX, PsycInfo and PsycArticles until November, 30, 2023. Studies that focused on pNFB in children with ADHD were selected, deviant studies excluded. Quality ratings by independent raters using Loney's1 criteria were conducted. Pooled effect sizes for NFB effects and methodological features were calculated. Results. Three of 109 studies included personalization and were reviewed in the full-text. In two studies, theta/beta-NFB was personalized using individual alpha peak frequencies (iAPF), whereas in one study, individual beta rhythms were trained. All three studies demonstrated significant short- and long-term improvements in ADHD symptoms, as assessed by questionnaires and objective performance tests, when compared to standard protocols (SP), sham-NFB, and control conditions. Twelve of 111 studies reported methodological features consistently related to NFB effectiveness. These features, including self-control instructions, feedback animations, timing of feedback presentation, behavioral performance, pre-recorded individual ERP-components and stimulant medication dosage, can be used to personalize NFB and enhance training success. Conclusion. Personalizing NFB with iAPF appears promising based on the existing -albeit small- body of research. Future NFB studies should include iAPF and other personalized features facilitating implementation consistently associated with treatment success.

The interplay of ADHD, social media usage, and dopamine receptors in adolescents: A literature review

ADHD is a neurodevelopmental disorder marked by symptoms such as inattentiveness, hyperactivity, and impulsivity, with a prevalence rate exceeding 5%. The pathophysiology of ADHD includes cognitive and functional brain abnormalities, particularly in the anterior cingulate gyrus and dorsolateral prefrontal cortex, as well as decreased activity in the frontostriatal region. Diagnosis involves comprehensive assessments based on behavioral criteria outlined in the DSM-5. Treatment primarily includes stimulant medications, which are effective in about 70% of patients, and non-stimulant options such as atomoxetine and antidepressants. The review explores the effects of social media on adolescents, highlighting both negative impacts, such as social isolation, depression, and cyberbullying, and positive aspects, such as enhanced communication and knowledge sharing. Adolescents with ADHD are particularly vulnerable to behavioral addictions due to their poor impulse control, making them susceptible to excessive social media use. Additionally, the role of D2-dopamine receptors in ADHD is discussed, noting that genetic components like the DRD2 gene can affect dopamine neurotransmission, impacting attention and pleasure experiences. The pleasure principle, as proposed by Freud, is also analyzed in the context of ADHD, suggesting that individuals with ADHD may engage in behaviors that provide immediate gratification to avoid discomfort. Therefore, this review underscores the correlation between ADHD symptoms, social media usage, dopamine receptor function, and the underlying psychological drives in adolescents, providing a comprehensive understanding of these interrelated factors.

Cocaine- and Levamisole-Induced Vasculitis: Defining the Spectrum of Autoimmune Manifestations.

Drug-induced or associated vasculitis is a prevalent form of vasculitis that resembles primary idiopathic antineutrophil cytoplasmic autoantibody (ANCA) vasculitis (AAV). Cocaine is a diffuse psychostimulant drug and levamisole is a synthetic compound used to cut cocaine. Their abuse may result in a spectrum of autoimmune manifestations which could be categorized into three overlapping clinical pictures: cocaine-induced midline destructive lesion (CIMDL), levamisole-adulterated cocaine (LAC) vasculopathy/vasculitis, and cocaine-induced vasculitis (CIV). The mechanisms by which cocaine use leads to disorders resembling AAV are not well understood. Cocaine can cause autoimmune manifestations ranging from localized nasal lesions to systemic diseases, with neutrophils playing a key role through NETosis and ANCA development, which exacerbates immune responses and tissue damage. Diagnosing and treating these conditions becomes challenging when cocaine and levamisole abuse is not suspected, due to the differences and overlaps in clinical, diagnostic, therapeutic, and prognostic aspects compared to primary idiopathic vasculitides.

Gabapentinoids Increase the Potency of Fentanyl and Heroin and Decrease the Potency of Naloxone to Antagonize Fentanyl and Heroin in Rats Discriminating Fentanyl.

Despite a significant decrease in the number of prescriptions for opioids, the opioid crisis continues, fueled in large part by the availability of the phenylpiperidine mu opioid receptor (MOR) agonist fentanyl. In contrast, the number of prescriptions for and the off-label use of gabapentinoids (gabapentin and pregabalin) has increased dramatically, with gabapentinoids commonly detected in opioid overdose victims. Although gabapentinoids can decrease the potency of the opioid receptor antagonist naloxone to reverse heroin-induced hypoventilation in male rats, the specificity and nature of interaction between gabapentinoids and MOR agonists and any potential sex difference in those interactions are not well characterized. Gabapentinoids were studied in female and male rats discriminating fentanyl (0.0032 mg/kg, i.p.) or cocaine (3.2 mg/kg, i.p.). Alone, neither gabapentin nor pregabalin significantly increased fentanyl- or cocaine-appropriate responding. In rats discriminating fentanyl, each gabapentinoid dose-dependently shifted the fentanyl and heroin discrimination dose-effect functions to the left, whereas naloxone dose-dependently shifted the fentanyl and heroin discrimination dose-effect functions to the right. Each gabapentinoid (100 mg/kg) significantly decreased the potency of naloxone to antagonize the discriminative stimulus effect of fentanyl or heroin. In contrast, each gabapentinoid dose-dependently shifted the cocaine and d-methamphetamine discrimination dose-effect functions to the right. There were no significant sex differences in this study. These results suggest that gabapentinoids impact the misuse of opioids, the co-use of opioids and stimulant drugs, and the increasing number of overdose deaths in individuals using opioids, stimulant drugs, and gabapentinoids in mixtures. SIGNIFICANCE STATEMENT: The number of prescriptions for and the off-label use of gabapentinoids (gabapentin and pregabalin) has increased dramatically, with gabapentinoids commonly detected in opioid overdose victims. This study reports that in rats gabapentinoids increase the potency of fentanyl and heroin to produce discriminative stimulus effects while decreasing the potency of naloxone to antagonize those effects of fentanyl and heroin. These results can help guide policies for regulating gabapentinoids and treating opioid misuse and overdose.

Brain homogenate stability for stimulant drugs.

Brain can be a useful specimen for toxicology testing as it is a protected and isolated organ with lower metabolic activity than other tissues, but there is currently no published data supporting the stability of stimulant drugs in prepared brain homogenates. Brain homogenates were evaluated to determine the stability of the following stimulant drugs: amphetamine, benzoylecgonine, bupropion, cocaethylene, cocaine, ephedrine, methylenedioxyamphetamine, methylenedioxymethamphetamine, methamphetamine, and phentermine. Four different homogenates were prepared at a 1:4 dilution with deionized water and fortified at 500 ng/mL of: cocaine without sodium fluoride, cocaine with 1% sodium fluoride, stimulant drugs other than cocaine without sodium fluoride, and stimulant drugs other than cocaine with 1% sodium fluoride. The fortified homogenates were aliquoted into 13 × 100-mm screw cap tubes and stored at room temperature (∼20°C), refrigerated (2-8°C), or frozen (<-5°C) and analyzed in triplicate on Days 0, 1, 3, 7, 14, 30, 60, and 90. Analytes were considered stable as long as the difference in analyte/internal standard response ratio from Day 0 was less than 20% and the peaks met qualitative acceptance criteria. All analytes were stable for up to 90 days when stored frozen with or without sodium fluoride and had variable stability at all other evaluated conditions.

Caffeine Inhibits Both Basal and Insulin-Activated Urate Transport.

Caffeine, an adenosine receptor antagonist, is a potent central nervous system stimulant that also impairs insulin signaling. Recent studies have suggested that coffee consumption lowers serum urate (SU) and protects against gout by unknown mechanisms. We hypothesized that caffeine lowers SU by affecting activity of urate transporters. We examined the effect of caffeine and adenosine on basal and insulin stimulation of net 14C-urate uptake in the human renal proximal tubule cell line PTC-05 and on individual urate transporters expressed in Xenopus laevis oocytes. We found that caffeine and adenosine efficiently inhibited both basal and insulin stimulation of net 14C-urate uptake mediated by endogenous urate transporters in PTC-05 cells. In oocytes expressing individual urate transporters, caffeine (>0.2 mM) more efficiently inhibited the basal urate transport activity of GLUT9 isoforms, OAT4, OAT1, OAT3, NPT1, ABCG2, and ABCC4 than did adenosine without significantly affecting URAT1 and OAT10. However, unlike adenosine, caffeine at lower concentrations (<0.2 mM) very effectively inhibited insulin activation of urate transport activity of GLUT9, OAT10, OAT1, OAT3, NPT1, ABCG2, and ABCC4 by blocking activation of Akt and extracellular signal-regulated kinase. We postulate that inhibition of urate transport activity of the re-absorptive transporters GLUT9, OAT10, and OAT4 by caffeine is a key mechanism in its urate-lowering effects. Additionally, the ability of caffeine to block insulin-activated urate transport by GLUT9a and OAT10 suggests greater relative inhibition of these transporters in hyperinsulinemia.

Decreases in mucosally-evoked tachykinin signaling pathways can explain age-related reductions in murine colonic motility patterns.

Increasing age increases the incidence of chronic constipation and fecal impaction. The contribution of the natural aging process to this phenotype is unclear. This study explored the effects of age on key motility patterns in the murine colon and determined the contribution that altered neurokinin 2 (NK2) -mediated signaling made to the aging phenotype. Mucosal reflexes, colonic migrating motor complexes (CMMCs) and colonic motility assays were explored in isolated exvivo colons from 3, 12-14, 18- and 24-months old mice and the NK2-mediated response determined. Electrical field stimulation (EFS) or exogenous drug application were used to explore the role of the mucosa in colonic segments. Aging reduced the force of contraction of the distal colon mucosal reflex, the frequency and force of contraction of CMMCs and the NK2-mediated component of both motility patterns. Ondansetron, a 5-HT3 receptor antagonist, blocked a component of both motility patterns in full thickness but not in mucosa-free segments of the distal colon. 5, hydroxytryptamine (5-HT) and EFS-evoked NK2-dependent contractions were reduced with increasing age. Smooth muscle sensitivity to 5-HT or neurokinin A (NKA) was not altered with age. In isolated colon motility assays application of NKA decreased transit time in 24-months colon and the NK2 antagonist GR159897 increased transit times in both 3- and 24-months old colons. Aging impairs key motility patterns in the murine colon. These changes involve a decrease in mucosally-evoked NK2-mediated signaling. Targeting NK2-mediated signaling may provide a novel approach to treating age-related motility disorders in the lower bowel.

Utilization of medicinal herbs among soccer athletes in the West Bank of Palestine

IntroductionHerbal supplements are popular among athletes, yet research on their types, purposes, and information sources is limited, particularly for Palestinian soccer players. This study aims to fill this gap by examining the types of herbal supplements used by young soccer athletes in the West Bank, their purposes, and the sources of information influencing their use. Understanding these aspects is crucial for safely and effectively integrating traditional remedies into modern sports nutrition. MethodsIn 2023, we conducted a cross-sectional study with young soccer athletes in the West Bank. We utilized a validated survey to collect data on the types of herbal supplements, their preparation methods, and information sources. We analyzed the data for frequencies and use values (UV). ResultsOut of 165 invited athletes, 155 participated, with 144 confirming their current use of herbal supplements. The participants, aged 18–25 (mean age 20.34), employed a variety of preparation and consumption methods. Information sources comprised traditional knowledge, advice from herbalists ("Attar" in Arabic), and online trends. Herbs that enhance physical endurance and stamina had the highest UV of 3.93, highlighting their critical importance. Herbs for joint and muscle pain and central nervous system stimulation had UV of 2.28 and 2.10, respectively, reflecting their significant roles. Antistress and anabolic herbs had UVs of 1.28 and 1.21, respectively. The total UV of 10.81 indicates a substantial use of herbal supplements. We recorded 1,675 recommendations, with the primary uses being: enhancing physical endurance and strength (36.36 %), reducing joint and muscle pain (21.13 %), acting as a CNS stimulant (19.46 %), alleviating stress (11.82 %), and providing testosterone-like effects (11.22 %). The top 10 herbs were ginseng (7.46 %), small nettle (6.99 %), olive (6.63 %), date (5.85 %), chili pepper (5.43 %), green tea (5.19 %), fenugreek (4.84 %), soy (4.24 %), coffee (4.24 %), and mate (4.12 %), collectively accounting for about 55 % of all recommendations. ConclusionThis study identifies the top 10 herbs used by soccer athletes, as well as their role in modern sports nutrition. Future research should evaluate their effectiveness and safety, focusing on herbs like date and small nettle. Educating athletes on the proper use and risks of herbal supplements is essential.

Studies on the Bioactive Components and Antibacterial Activities of Kigelia Africana

Objective: Nature has been a source of medicinal agents for thousands of years and an impressive number of modern drugs have been isolated from natural sources. K. africana is a plant which various part have been used as antibacterial agents, antiprotozoal agents, antineoplastic agents, CNS stimulants e.t.c. Method: Fresh leaves and stem bark of K. africana were collected from Egugwu Agbaja Izzi LGA, Ebonyi State. The plant was washed, soaked, filtered and air-dried to get the aqueous extract. Semi quantitative phytochemical identification, Gas chromatography/Mass spectrometry as well as antibacterial assays of the extracts against C. freundii, E. coli, K. pneumonia and S. aureus by agar well diffusion method were carried out. The aqueous extracts were re-extracted to obtain an ethanolic fraction. Result: The aqueous extract of the leaf had more inhibitory effects than that of the stem bark on the test organisms. The aqueous extract had more inhibitory effects against S. aureus, K. pneumonia and C. freundii as compared to E. coli. The ethanolic fraction had a very significant (P˂0.05) inhibitory effect against all the test organism. Phytochemical analysis of the crude extracts showed the presence of glycosides, tannins, carbohydrate resin and reducing sugar in all extract while saponin and flavonoid was noted only in the aqueous extract of K. africana stem bark. The GC/MS revealed the presence of acetic acid, hydroxy-ethyl ester e.t.c in the leaf aqueous extract whereas phenol, 3-methoxy-2,4,6-trimethyl was revealed in the stem bark. Conclusion: This study revealed that aqueous extract of K. africana contains high amount of phyoconstituents and it may be responsible for its good antibacterial activity.

Impact of childhood adversity on acute subjective effects of stimulant and opioid drugs: Evidence from placebo-controlled studies in healthy volunteers.

Early-life adversities are known to alter drug reward processing in rodents. Despite the well-known link between early adversity and the risk of substance use disorder, few studies have measured how childhood adversity affects human drug reward. Here, we assessed the relationship between historical childhood adversities and responses to single doses of methamphetamine, d-amphetamine or buprenorphine in healthy participants. Using a secondary analysis approach, we assessed the impact of childhood adversity on drug effects from three randomised, placebo-controlled studies in which healthy volunteers received methamphetamine (20 mg oral; n = 35), d-amphetamine (20 mg oral; n = 54) or buprenorphine (0.2 mg sublingual; n = 35). Ratings of feeling effect, liking, disliking, feeling high and wanting more of the drug were collected 15-210 min post-administration, and heart rate changes were analysed using random-intercept mixed-effect models. The area under the curve from these and previous studies was calculated to visualise the relationship between childhood adversity severity and drug effects. Greater childhood adversity was associated with reduced feel effects (significant three-way interactions b = -0.07, 95% CI [-0.12, -0.02], p = 0.009), like effects (b = -0.07, 95% CI [-0.13, -0.00], p = 0.038) and feel high (b = -0.06, 95% CI [-0.10, -0.01], p = 0.020) towards the stimulant drugs 90-180 min post-administration. Childhood adversity was not significantly associated with other subjective or heart rate responses to the drugs. Overall, participants with more childhood adversities reported dampened subjective responses to stimulant drugs, but not to buprenorphine. Future studies should examine the generalisability of these relationships, to identify the mechanisms underlying the link between childhood adversity and drug responsiveness.

Exploring Methylphenidate-Induced Intraocular Pressure: A Cautionary Tale in Pediatric ADHD Management.

This case report explores the intricate relationship between methylphenidate (MTX) use and increased intraocular pressure (IOP) in a pediatric patient with a preexisting history of eye disease. Despite existing literature presenting cases of IOP elevation linked to MTX, a significant gap remains in understanding nuanced risk factors. This case study used patients' medical records and a comprehensive literature review. A 6-year-old girl with attention deficit hyperactivity disorder and a family history of eye conditions exhibited elevated IOP after 12 days of MTX use, prompting discontinuation. The patient successfully transitioned to atomoxetine with normalized IOP and improved attention duration. Existing cases emphasize the potential link between sympathetic nerve activity and IOP elevation induced by central nervous system stimulants like MTX. Notably, the patient's high hyperopia contributed to the impact of MTX on IOP, suggesting the need for cautious use in susceptible individuals. This case underscores the importance of individualized treatment strategies, particularly in attention deficit hyperactivity disorder patients with family history and additional eye findings, emphasizing safety and comprehensive patient care.

Stimulant medications in the management of bulimia nervosa and anorexia nervosa in patients with and without comorbid attention deficit hyperactivity disorder: A systematic review.

People with attentional problems are at increased risk of eating disorders. This paper aimed to systematically review and synthesize the existing evidence on stimulant medication in the management of patients with bulimia nervosa (BN) or anorexia nervosa (AN) with or without comorbid attention deficit hyperactivity disorder (ADHD). A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A protocol for the review was registered with Open Science Framework (OSF) Registry and critical appraisal of the literature was conducted using Joanna Briggs Institute (JBI) Critical Appraisal Tools. Thirteen articles met inclusion criteria including two quasi-experimental studies, one randomized controlled trial, four case series, and six case reports. 26 cases were included from studies and 32 from case series/reports. Only two cases from a single case report had a diagnosis of AN, while the remainder had BN. Stimulants included methylamphetamine, lisdexamfetamine, methylphenidate, dextroamphetamine sulphate and mixed amphetamine salt. In nearly all cases of BN there were reported reductions in eating disorder symptoms. The rates of adverse effects were high and included weight loss, decreased appetite, tachycardia, dry mouth, fatigue, insomnia, restlessness, nausea, bruxism, headache, palpitations, blood pressure changes, irritability, anxiety, depressed mood, and diaphoresis. There is currently insufficient evidence to support the use of stimulant medications to treat symptoms of BN or AN. The authors recommend considering screening patients with BN for ADHD.

Increased risky choice during forced abstinence from fentanyl on the cued rat gambling task.

The use of illicit opioids has arguably never been more risky; street drug potency can be dangerously high, is often unknown to the consumer, and results in multiple daily fatalities worldwide. Furthermore, substance use disorder (SUD) is associated with increased maladaptive, risky decisions in laboratory-based gambling tasks. Animal studies can help determine whether this decision-making deficit is a cause or consequence of drug use. However, most experiments have only assessed psychostimulant drugs. To assess differences in decision-making strategies both before, during, and after self-administration of fentanyl in male and female Long Evans rats. Male and female Long Evans rats were trained to perform the rat gambling task (rGT), loosely based on the Iowa Gambling Task (IGT) used clinically, and/or self-administer fentanyl. We used the cued version of the rGT, in which sound and light stimuli signal sugar pellet rewards, as cocaine self-administration has the greatest effects on decision making in this task variant. After training on the cued rGT, female rats self-administered fentanyl more readily, an effect that was most apparent in optimal decision-makers. Contrary to previous reports using cocaine self-administration, decision-making was unaffected during fentanyl self-administration training in either sex. However, risky decision-making increased throughout forced abstinence from fentanyl in males. These findings complement those from human subjects, in whom preference for uncertain outcomes increased before relapse. These data highlight an abstinence-induced change in cognition that is unique to opiates as compared to psychostimulants, and which may critically contribute to the maintenance of addiction and relapse.

Exploration of Analgesic, Anti-Inflammatory, Neuropharmacological and Antidiabetic Activities of Clerodendrum viscosum Root Extract

In the traditional systems of medicine, Clerodendrum viscosum (CV) has important medicinal uses for the treatment of asthma, ulcer, inflammation, pyrexia, diabetes etc. In this study, analgesic, anti-inflammatory, neuropharmacological and antidiabetic effect of root extract of C. viscosum (CV) was investigated. Mice (Swiss albino) of either sex of 25-30 g were distributed into 4 groups as control (normal water), standard (STD), CV 250 mg/kg and CV 500 mg/kg (n=6). Analgesic effect was investigated by acetic acid initiated writhing test, formalin initiated paw licking test and hot plate test. Anti-inflammatory effect was investigated by xylene and croton oil initiated ear edema test and cotton pellet pleurisy test. Pentobarbital mediated sleeping time and hole cross tests were applied to assess neuro-pharmacological activity. Antidiabetic effect was evaluated by in-vitro alpha amylase inhibitory assay. In the acetic acid initiated writhing test, formalin test and hot plate test, the alcoholic extract of root showed significant antinociceptive activity (p&lt;0.01) at 500 mg/kg dose. The test extract lowered inflammation in xylene, croton oil and cotton pellet test which was significant (p&lt;0.001). The 500 mg/kg dose significantly (p&lt;0.001) increased onset time of sleeping and significantly reduced sleeping duration (p&lt;0.01) in sleeping time test. It also showed insignificant effect in hole-cross test. The extract exhibited a good alpha amylase inhibitory potential (IC50=1.24 mg/ml). C. viscosum root exhibited analgesic, anti-inflammatory, antidiabetic as well as CNS stimulant effect in model mice used for experimental purpose. More investigations are needed for the evaluation of such activities as well as the potential of this plant. Bangladesh Pharmaceutical Journal 27(2): 164-174, 2024 (July)

Worsening trends in the frequency of methamphetamine and other stimulant use between treatment admission and discharge

BackgroundTreatment for methamphetamine and other stimulants can be effective but treatment attrition and continued use are very high. Abstinence is the conventional outcome used to evaluate treatment success, but defining treatment success in this way misses opportunities to promote improved health even when abstinence is not achieved. Reducing methamphetamine and stimulant use without abstinence is associated with many positive outcomes. However, little is known about drug use patterns during treatment or trends in use over time. MethodsWe used the Treatment Episode Dataset-Discharges (TEDS-D) to identify treatment episodes that had a stimulant drug indicated as the primary substance of use (2017–2021; N=251,841; methamphetamine, cocaine, other amphetamines, or other stimulants). Our outcome was the change in the frequency of drug use between admission and discharge (decreased use with abstinence, decreased use without abstinence, increased use). We used multiple logistic regression to model a change in drug use frequency, predicted by year, stimulant type, and their interaction. ResultsNearly two-thirds of the sample (60 %) had methamphetamine indicated as the primary stimulant of use. There was a decrease in the predicted rate of abstinence over time and worsening trends were strongest among those using methamphetamine. Daily and periodic drug use at both admission and discharge (no change in use) became worse over time, particularly for those using methamphetamine. ConclusionTreatment outcomes worsened over time and declined fastest among those reporting methamphetamine. Abstinence was rare and most treatment clients did not change their drug use behavior. We recommend a renewed focus on evidence-based harm reduction while the nation’s treatment systems continue grappling with the stimulant crises.

TAPS-tool reveals severe under detection of substance use problems in patients with severe mental illness.

Substance use disorders (SUD) and associated problems are highly prevalent but often undetected in patients with Severe Mental Illness (SMI). This study investigates the prevalence, under-detection, and variables associated with a high risk of SUD in a Dutch sample of adult outpatient SMI patients (N = 83). Substance use (The Tobacco, Alcohol, Prescription medication, and other Substance use -TAPS-tool), quality of life (Manchester Short Assessment of Quality of Life-MANSA), general functioning (Health of the Nation Outcome Scale-HoNOS), DSM-5 classifications and patient characteristics (age, education, marital status) were assessed. Detection of SUD was determined by calculating % agreement of DSM-5 classification to TAPS outcome. A logistic regression analysis was performed to determine the association of patient characteristics, quality of life and general functioning to an increased risk of SUD as determined by the TAPS. Concerning prevalence, 89% of the patients used tobacco, above guideline-recommended daily limits of alcohol, illicit drugs or prescription medications for nonmedical purposes. Almost all smokers, half of the alcohol users and three-quarter of the patients that use marihuana or stimulant drugs had a high risk of SUD. All patients with high risk of SUD associated with alcohol, drugs or medications also had SUD associated with tobacco use. Concerning under detection less than half of the patients with a high risk of SUD according the TAPS had a SUD in their DSM-5 classification. Gender, partner, age and satisfaction about the relationship with family had a significant association with a high risk of SUD. Screening for addiction in an SMI sample with the TAPS-tool revealed a high prevalence of substance use and a high risk of SUD. TAPS outcomes compared to the clinically obtained DSM-5 classification revealed a high degree of under-detection of substance use problems. Smoking seems to pose a specific additional risk of addiction and deserves more attention in treatment to achieve greater health care benefits.

Malignant Catatonia in the Setting of Acute Methamphetamine and Cocaine Intoxication.

Malignant catatonia is a potentially lethal neuropsychiatric syndrome characterized by psychomotor abnormalities and autonomic instability. Patients with this syndrome require immediate treatment. Various psychiatric conditions and nonpsychiatric medical problems can trigger malignant catatonia. Use of psychostimulant drugs, including methamphetamine and cocaine, has not been previously reported to precipitate malignant catatonia. This case concerns a 35-year-old man hospitalized for psychosis due to methamphetamine and cocaine intoxication. He developed malignant catatonia the day after admission. He was treated with lorazepam for malignant catatonia, and his blood pressure was controlled with clonidine. Over 7 days, his condition resolved, and his mental status and vital signs returned to baseline. He was discharged to the community in stable condition and has returned to his baseline functional status. He remains free of catatonia and has maintained abstinence from methamphetamine and cocaine. Acute intoxication with psychostimulant drugs is a possible trigger for malignant catatonia, and administration of high potency first-generation antipsychotics in this setting may increase the risk. Patients hospitalized for stimulant intoxication should be monitored for signs and symptoms of catatonia, and D2 receptor antagonist medications should be used with caution in this population. Our case supports the potential role of altered dopamine and norepinephrine signaling in the pathogenesis of malignant catatonia. The patient provided written and verbal consent to publish the information in this case report.

Electrical stimulation in special clinical situations

Introduction: Neuromodulation is an approach used to treat diseases that are refractory to clinical treatments by employing electrical and chemical stimulation techniques, especially in cardiac, neurological, and psychiatric disorders. Objective: This study aims to provide an overview of the latest developments in neuromodulation therapies that use electrical stimulation. Methods and results: The present study describes the most common neuromodulation techniques. Neuroplasticity is used to adjust the ions and neural excitability in response to central and peripheral nervous system stimulation. The spinal cord, dorsal root, and gastric stimulations are effective treatments for neuropathies, chronic pain, muscle spasticity, epilepsy, depression, cluster headaches, heart failure, and gastroparesis symptoms. Deep brain stimulation and invasive cortical stimulation are medical procedures used selectively to treat Parkinson’s disease, dystonia, obsessive-compulsive disorder, and chronic pain. Barostimulation therapy is beneficial in controlling refractory hypertension, reducing the risk of cardiovascular events, and improving overall quality of life. Repetitive Transcranial Magnetic Stimulation is a recommended treatment option for fibromyalgia, neuropathic pain, chronic headaches, treatment-resistant depression, generalized anxiety disorders, schizophrenia, and attention deficit disorder. While controlling obesity shows promise in regulating appetite and promoting satiety, more research is needed to understand the safety and efficacy of these therapies in various groups. Conclusion: Neuromodulation devices hold promise for treating diseases that do not respond to clinical treatments. Additional clinical trials and studies are required to understand it fully.